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Federal forms, ICRs, and supporting documents

Information Collection

Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

IC 28212 under ICR 202404-2900-002 · OMB 2900-0067.

Documents and Forms
Document Name
Document Type
Form
Form
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Information Collection (IC) Details

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Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 3.808

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 21-4502 Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) VA Form 21-4502 (Q9 7-24-24).pdf www.va.gov/vaforms Yes No Fillable Printable

General Government Legislative Functions

Compensation, Pension, Education, and Veteran Readiness and Employment Records-VA (58VA21/22/28)  87 FR 8740

12,786 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 12,786 0 11,141 0 0 1,645
Annual IC Time Burden (Hours) 3,197 0 2,786 0 0 411
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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